Because of my irregular schedule, I don't do outpatient infectious disease work anymore. There are times that I am thankful I made that decision, especially when a "chronic" Lyme patient happens to stumble upon my name online and wants to see me, and times I think about finding a way to do some outpatient work. Those positive thoughts are usually triggered by remembering my experiences treating HIV in an outpatient setting. It's not that I don't see HIV patients in the hospital and don't keep up with HIV anymore -- I am on Pittsburgh's HIV commission -- there's just something I miss about taking care of HIV patients in the outpatient setting. Outpatient care, I think, is much more personal allowing the physician to truly know a patient and the ups and downs of an illness over a longer period of time than during acute and brief episodes in the hospital. The satisfaction of seeing medications work or strategizing with a patient over the best long-term plan of care are all hallmarks of outpatient care that I sometimes miss.
It may seem odd that someone misses HIV clinic, but if you have ever practiced in one you would know exactly what I mean. I just finished Dr. Susan Ball's Voices in the Band: A Doctor, Her Patients, and How the Outlook on AIDS Care Changed from Doomed to Hopeful a memoir of her day-to-day work at the renowned HIV clinic at Cornell in New York City the Center for Special Studies, and all my own memories are becoming vivid again.
Dr. Ball's tenure, which is ongoing, spans an important epoch in HIV history that saw HIV metamorphose, through the development of antiretroviral therapies, from a death sentence to a chronic illness and her narrative is therefore uniquely positioned to tell this important story.
Voices in the Band is a poignant, emotion-evoking story of one dedicated physician's experience of being literally immersed in a plague in which people died, orphans abounded, and myriad social calamities compounded the destruction wrought by a virus. As she puts it, "HIV existed as an addendum" in many patient's lives. Dr. Ball's vignettes of patients, their stories, and their coping mechanisms coupled with her own mind's analysis of how to provide the best care possible was, to me, the best feature of this book. Understanding her perspective and how she integrated each patient's individual context, some of which were endlessly complex, was, to me, the best aspect of this book.
While the unique situations faced by an HIV physician in one of the epicenter's of the pandemic during its heyday may be appear, at first glance, to be very different to what a clinician treating HIV today may face, many of the same issues -- save the lack of effective therapies -- persist.
Dr. Ball's resilience and unequivocal commitment in being the best physician to her patients shines through the book and is exemplary. When she describes writes of her practice, "So much I’ve seen and so much more still to see" one is glimpsing the standing order of an active mind engaged passionately in a productive activity that it loves.
One of my favorite descriptions is her view of the role of an HIV (or infectious disease physician) as "trekking on another planet, exploring unknown territory where few wanted to go...where we shared a sense of being alive, of doing something brave and important."
